The aim of this study is to evaluate the levels of Th17 cell-associated cytokines (IL-17, IL-21, IL-23) and the salivary stress biomarkers cortisol, dehydroepiandrosterone, and Chromogranin A in the pathogenesis of periodontal disease in individuals with psoriasis, thereby revealing immunological and neuroendocrine interactions.
The fundamental question it aims to answer is:
What are the biological mechanisms that may increase the risk of periodontal disease in individuals with psoriasis?
In this context, the periodontal status of individuals with psoriasis will be clinically assessed, followed by analysis of the levels of Th17-associated cytokines and stress biomarkers in gingival crevicular fluid and saliva samples. Additionally, patients will be asked questions from the Social Appearance Anxiety Scale. The periodontal status of individuals with psoriasis will be determined cross-sectionally, and the resulting biomarker levels will be examined. In addition, the data obtained will be evaluated with statistical analysis in relation to disease severity and clinical parameters.
Being between the ages of 18 and 65
Being diagnosed with psoriasis by a dermatologist
Having at least 20 teeth
Not having received periodontal treatment in the last 6 months
<20 teeth
Any significant oral infection (i.e., herpes or candidiasis)
Oral injuries or bleeding unrelated to periodontitis
Periodontal therapy and antibiotic therapy within the past 3 months
Patients diagnosed with psoriasis who came to the Periodontology Clinic of Recep Tayyip Erdoğan University Faculty of Dentistry for routine periodontal treatment
Case-only
Cross-sectional
Not listed
Gingival Crevicular Fluid (GCF) Collection
Specimens will be collected from four different teeth from each participant, each with the deepest pocket. Before collection, supragingival plaque will be gently removed with sterile curettes, the surfaces will be dried, and the tissue will be isolated with cotton rolls. Filter paper strips will be carefully inserted into the sulcus until slight resistance is felt, or no deeper than 1 mm to prevent mechanical trauma in patients with periodontitis. The strips will be left in the sulcus/pocket for 30 seconds. The GCF volume of each strip will be measured using a pre-calibrated electronic device (Peritron 8000). Four strips from each participant will be placed in coded sterile Eppendorf tubes and stored at -80°C until analysis.
Saliva sampling
Prior to saliva collection, participants will be instructed to abstain from caffeine and/or nicotine for at least 4 hours and alcohol for at least 24 hours. Participants will be asked to rinse their mouth with water and wait 5 minutes to prevent contamination. After waiting, they will be asked to collect saliva in the bottom of their mouth and then spit into a sterile metal cup for another 5 minutes. Unstimulated saliva samples will be transferred to sterile Eppendorf tubes. Saliva flow rate will be calculated by dividing the total saliva volume by the collection time for each participant. Samples will be stored at -80°C until the day of laboratory analysis.
Clinical Periodontal Parameters (Plaque Index)
Plaque Index (PI) (Silness and Löe, 1964) This index is used to evaluate the amount of dental plaque accumulation on tooth surfaces. Each tooth's four surfaces (buccal, lingual, mesial, distal) are examined using a probe or visually. Each surface is scored from 0 to 3. The average score is calculated for each tooth. The overall plaque index is obtained by averaging the scores from all examined teeth. Score Description 0 No plaque. 1. No visible plaque, but a slight film of plaque is detected when a probe is run along the gingival margin. 2. Visible plaque along the gingival margin, forming a continuous band. 3. Abundant plaque covering the gingival area and extending toward the middle of the tooth surface, including the interproximal spaces.
Clinical Periodontal Parameters (Gingival Index)
The Gingival Index is used to assess the presence and severity of gingival inflammation (gingivitis). Four surfaces of each tooth (buccal, lingual, mesial, distal) are examined visually and with a periodontal probe. The evaluation considers color changes, edema (swelling), tissue consistency, and bleeding on probing. Each surface is scored from 0 to 3. The average score per tooth is calculated, and then the overall average is used to determine the individual's GI score. Score Description 0 Healthy gingiva: normal color and texture, no bleeding 1. Mild inflammation: slight color change and swelling, no bleeding on probing 2. Moderate inflammation: redness, edema, soft tissue, bleeding on probing 3. Severe inflammation: marked redness and swelling, ulceration, possible spontaneous bleeding
Analysis of cortisol, dehidroepiandrosteron (DHEA) and chromogranin A
Salivary cortisol, DHEA, and chromogranin A will be obtained from unstimulated whole saliva samples. Human salivary cortisol will be measured using a commercial enzyme-linked immunosorbent assay (ELISA) radioenzyme immunoassay kit according to the manufacturer's instructions. An ELISA kit will be used to measure DHEA, and the Human Chromogranin A ELISA Kit will be used to measure chromogranin A levels. Saliva samples will be kept on ice and stored at -20°C until analyzed. On the day of analysis, saliva samples will be centrifuged at 2000×g for 10 minutes to remove particulate material. All samples will be processed in triplicate during the same assay. Statistical analyses will be performed using the average of three replicate measurements.
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